Mental health therapies grow and change

There is more to treating mental health disorders than swallowing a pill and hoping to feel better. Unconventional treatments which are becoming accepted in the search for wellbeing include mindfulness, hypnotherapy and magnetic fields.

MARNIE McKIMMIE

February 25, 2015

Repetitive Transcranial Magnetic Stimulation (rTMS)

What is it?

Stimulates a selected area of the brain with a rapidly changing magnetic field to treat major depressive disorders. The field passes through the scalp and skull and generates electrical pulses in the brain.

How does it work?

Causes neurons to fire and modifies blood circulation and other brain processes, which can trigger a reduction in depression symptoms or a remission. Unlike with ECT (electro-convulsive therapy using a small electric current), rTMS does not induce a convulsion, does not require anaesthetic or muscle relaxants and does not cause memory impairment. The patient sits in a chair, fully conscious and is later able to drive home. A stimulus coil is positioned so as to just touch the head and the sensation of the magnetic field may cause a “ping” on the skin of the scalp. A session takes 20 minutes and is carried out five days per week for about a month.

It started in 2005 as a research program at the neuro-physiology Unit at the WA Health Department’s Graylands campus and developed into a treatment unit in 2011. Part of the North Metropolitan Health Service Mental Health, it is the only publicly funded clinic now running in Australia.

Who does it help?

Used mainly for those with treatment-resistant depression — resistant to medication, psychotherapy and, in some, ECT and aged from 18 to 80-years-old plus, with a range of severity.

“Some have tried almost every available treatment for depression and all have failed,” said consultant psychiatrist, University of WA professor of psychiatry Joseph Lee. “Or they can’t tolerate other treatments, as they have a lot of side-effects.”

There is the potential for the unit to eventually provide for 80 patients a year.

Is it effective?

Clinical trials, conducted at the local unit and elsewhere had shown it produced results comparable to ECT for major depression, said Professor Lee.

His unit’s review of the 141 patients who completed a treatment course found 30 per cent went into remission and 40 per cent had a significant reduction in symptoms.

“It is quite a pleasing outcome given these patients had not been helped by other treatments,” he said. “When we compared the efficacy to antidepressants, it works better than antidepressants.”

However, Professor Lee said it was not a cure. “Its effect does not last forever,” he said. “Some people will stay well for quite a long time and others will have a relapse and return of symptoms in a matter of months.”

Average duration of remission, not maintained by medication, was about five months.

The most common side effect was a mild tension headache eased by over-the-counter medications. This occurred because the magnetic field could stimulate nerve endings and muscles.

For other psychiatric and neurological conditions, it was still in the experimental stage, said Professor Lee. There was hope it may prove effective for negative symptoms and auditory hallucinations in schizophrenia and for chronic pain and treatment-resistant epilepsy.

Eye Movement Desensitisation and Reprocessing

What is it?

Aimed at trauma recovery, it uses rapid eye movements to stimulate the brain’s information processing system and reduce the vividness and emotional intensity of upsetting, unwanted rich-in-detail memories. A therapist has a patient focus on the worst memories, while moving eyes back and forward at a rate of once per second.

How does it work?

Making rapid side-to-side eye movements during recall is thought to grab attention and compete with the recollection for space in the brain’s working memory. This causes the trauma memory to be less intense when recalled. Also rapid eye movements while awake might help “restart the natural healing process” in trauma patients suffering disruption to rapid eye movement sleep, the stage when emotional memory processing occurs, said Chris Lee, Murdoch University senior lecturer in psychology.

Who does it help?

Trauma patients, those with post-traumatic stress disorder. Dr Lee said there were indications it could assist with depression, by working on vivid trauma-like memories of critical comments such as “being a failure”. “Traumatic memories can become the focus of a person’s being,” he said. “We even think they might be stored in a different part of the brain.”

Is it effective?

Backed by the World Health Organisation, Dr Lee said worldwide studies showed it was effective but researchers were still trying to “work out why”. His recent work using MRI and PET scans had detected changes in the brain, along with reduction in symptoms, after six weeks of eye movement therapy.

Dialectical Behaviour Therapy

What is it?

Used worldwide for those chronically suicidal or emotionally distressed, it is a psychological treatment aimed at fostering new behaviour and described by patients as providing a way “to put on the brakes”. Developed in the late 1980s by University of Washington mental health researcher Marsha Linehan, who was driven by a mission to “rescue” people with self-destructive urges, often as a result of borderline personality disorder. According to a report in the New York Times, she has fought her way back from her own “hell”, having spent a year, at the age of 17, in a secure US mental- health facility for self-harm and later attempted suicide.

“Marsha got her life together and has given something amazing to the world,” said Pauline Cole, North Metropolitan Health Service psychiatrist.

The basic idea for DBT is that change occurs through “radical acceptance” and that learning new behaviours and acting differently can, in time, assist with emotion regulation.

How does it work?

An initial year-long module-based program provided a way for those in “intolerable pain” and “flooded with hurt, anxiety, shame and anger” to mindfully “walk the middle path”, Dr Cole said.

With DBT, it was about not judging, she said, but recognising that how people felt, thought and behaved “made sense” and yet might need to change.

“It is understandable that a person in such pain might feel like they can't go on,” she said. “But the therapist helpsidentify the spark inside them that still wants to be alive and works to build a new balanced position.” The focus is on gaining commitment to change, developingbehaviour and emotional control, resolving quietdesperation and trauma, dealing witheveryday living problems and finally assisting peopletofeel complete. Skills include mindfulness, dealing with distress, toxic emotions, problem solving and assertive communication skills. Individual, group therapy, consultation groups and phone coaching are provided.

Who does it help?

It has been developed to focus on problematic behaviour patterns rather than a particular diagnosis. While DBT has primarily been used for borderline personality disorder — a condition where medications helped little and often led to long-term hospitalisation — there is emerging evidence it could assist with depression, anxiety disorders, eating disorders, substance-abuse disorders and possibly treatment-resistant schizophrenia.

Effective yet simple, Dr Cole said there was scope for DBT programs to be run in GP clinics by trained staff and used by crisis-call phone services. At the moment, to her knowledge, her Osborne Park-based WA Health Department-funded comprehensive DBT program was the only one in Perth “run exactly by the book”. Provided by the North Metropolitan Health Service, with a significant waiting list, it is only able to cater for 13 patients a year and is restricted to women. Rough costestimates to run the full program in the private sector might involve out-of-pocket costs of about $12,000 a year, she said.

Is it effective?

Worldwide studies had shown the effectiveness and it was now considered a “mainstream, stock-standard treatment” for borderline personality disorder, Dr Cole said. “This is a treatment that works,” she said. However, it was most effective if run by the manual and “not watered down”.

Mindfulness

What is it?

Similar to meditation but broader and involves learning daily practices to be more present and aware and to develop a less-reactive relationship to negative thoughts and feelings. Aims at reducing the worst effects of stress and negative moods by “having a less judgmental and more compassionate stance”, according to clinical psychologist Mark Craigie. The Mindfulness-Based Stress Reduction 8-week program was developed at the University of Massachusetts medical school in 1979 for chronic pain.

How does it work?

“It is about awareness, attention and intention,” Dr Craigie said. “It helps you focus better on the task at hand, rather than be so easily distracted by emails, a mobile phone and thoughts of the past and future.

“Mindfulness can help you steady and untangle from that whirlpool of negative thinking that can accompany negative moods and emotions. It doesn’t make the negative thoughts and feelings immediately go away, but it does help you gain some distance, and then decide if you wish to just let them go, question them or perhaps choose alternative actions.

“In a way, you are less likely to be swept away by your thoughts and take the world so personally.”

For preventing depression relapse and managing negative mood. Also assists with mental wellbeing, stress and anxiety management, and coping with chronic pain and cancer.

Is it effective?

Studies had shown MBCT reduced the risk of depression relapse by about 43 per cent for those with more than three previous episodes Dr Craigie said. And a recent study published in the journal Psychoneuroendocrinology reported evidence of specific molecular changes in the body following intensive mindfulness practice. University of Wisconsin-Madison researchers detected genetic and molecular differences, including reduced levels of pro-inflammatory genes.

Hypnotherapy

What is it?

Uses hypnosis, a procedure during which the therapist suggests that the individual experiences changes in sensations, perceptions, thoughts or behaviour.

How does it work?

Some people believe it can be used to help a depressed person to relax, reduce anxiety and overcome negative thoughts.

Is it effective?

There is no scientific evidence it works by itself but it is possible that there are some small benefits of adding hypnotherapy to cognitive behaviour therapy, reports ANU’sBluePages. Canadian researchers found that in people who were open to suggestion, this combination reduced depression symptoms by 6 per cent immediately following the trial.

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